POTUS and torture

It beggars belief that the leader of the free world and the world’s policeman, the President of the United States, thinks that torture is not a bad thing. On the campaign trail he insisted several times that torture works and that even if it didn’t “they deserve it anyway, for what they’re doing.”

Now that he is in office, however, Mr Trump seems to be having a two-way bet. While personally in favour of waterboarding, he is deferring to the opinion of his Secretary of Defense, James Mattis, a tough and experienced soldier, who says that it does not work. In this way, he keeps faith both with voters who want him to be tough on terrorism and voters who want him to rebuild the military.

So the upshot of this week’s confusing news about a draft executive order from the President permitting “enhanced interrogation” techniques is that no one really knows what he believes. But it is an ominous sign that Mr Trump’s moral compass is so weak that he resiles from repudiating torture, keeping it in reserve as a potential vote-winner. In a civilised society which respects human dignity, torture should be absolutely unthinkable.

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President Donald Trump

Donald Trump was a different sort of candidate and he gave a different sort of inaugural speech. It was short, sharp, divisive and isolationist, the kind of remarks that often precede a massive swamp-draining project. But in one respect it was similar to speeches by other presidents: bioethics was not a major theme.

He did say that "We stand at the birth of a new millennium, ready to unlock the mysteries of space, to free the earth from the miseries of disease" -- which sounds vaguely promising for scientific and medical research.

His twice-repeated invocation of the Almightly suggests that he might follow a Christian line on controversial issues like contraception, abortion and assisted suicide. 

But who knows? Mr Trump is a bit like that quintessentially American poet Walt Whitman -- "Do I contradict myself? Very well then I contradict myself, (I am large, I contain multitudes.)" No one really knows what he has in mind about a range of topics. Buckle up. It's going to be a bumpy ride.

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Waste not, want not

Transplant surgeons in Belgium and the Netherlands are already harvesting organs from patients who have requested euthanasia. Could this happen in Canada, the new kid on the euthanasia block? Perhaps. In a recent article in the Journal of Medical Ethics, two bioethicists from Quebec argue that organ donor euthanasia is a homage to autonomy and needs to be legalised. Apparently the Quebec government and the society of transplant surgeons in Quebec are on board.

Of all the bad ideas associated with euthanasia, this must be one of the worst. The potential for exploiting vulnerable people is immense. Imagine that you are a quadriplegic. Your organs are healthy; you are lonely, frustrated, discouraged. You see a TV program in which a doctor praises the unforgettable generosity of So-and-so whose life was not worth living but found a way to give life to others, etc, etc. Wouldn't you think of ringing up the doctor and asking him how to go about it? 

Will Canada be able to stop this from happening?

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Happy Christmas!

All the best to our readers for a Merry Christmas and a Happy New Year! BioEdge will be taking a break for a while. Our next email will arrive, depending on your time zone, around January 11. We plan to move to a mid-week, rather than a weekend, mail-out. 

Quite a few people have responded to our fund-raising campaign. We are very grateful for your support and generosity. The funds will help us to redesign the website in the new year. 

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The dignity of Mr 66 Garage

When there’s talk of border crossings and illegal Mexican migrants, my thoughts used to turn to the ugliness of Donald Trump’s dream: "I will build a great wall -- and nobody builds walls better than me, believe me --and I'll build them very inexpensively. I will build a great, great wall on our southern border.”

But after reading a remarkable feature in California Sunday Magazine, I’m trying to think about 66 Garage instead. The name of Mr 66 Garage may not ring a bell with you, but to be fair, it doesn't ring one with him either. He is an undocumented migrant whose truck overturned on a border crossing in June 1999. He hit his head and never woke up.

Ever since, 66 Garage has lived in a persistent vegetative state in a San Diego nursing home where he is given round-the-clock care. What a country America is! It produces a politician who treats illegal migrants as if they were cockroaches and nurses who treat them as if they were their own family.

Anyhow, this 18-20-year-old man had taken the “undocumented” part of his journey seriously. He could not be identified and the nursing home christened him 66 Garage, although some of the staff protested that it was undignified. A wonderful woman named Paula visited him every week for 15 years and wondered who he was.

There are thousands upon thousands of missing migrants and their relatives are desperate to find them. A photo of 66 Garage has been shared more than 300,000 times on Facebook. Earlier this year a friend of Paula’s took an interest in the case and 66 Garage was finally fingerprinted. A match led to his sister in the southern state of Oaxaca. Now she can wave at him over Skype on his birthday.

It’s a remarkable story about vulnerability, dignity, blood ties, and American generosity. Read it.

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Reflections on California’s assisted suicide legislation

California’s assisted suicide law came into effect on June 9. Betsy Davis, an artist with ALS, also known as Lou Gehrig’s disease, was one of the first to take advantage of the legislation. She drank a lethal cocktail on July 23, after a long party with close friends. I’m afraid that we missed the story at the time.

Reading her sister’s account of Betsy’s death, which is full of loving sorrow at her passing, I was struck by how quickly Californians started to ignore all the careful safeguards. It is clearly specified in the law that the person must “self-administer” the drug. But she was too weak to hold the cup and drink it quickly, so her friends held it for her. They may have broken the law.

People tend to think that a lethal barbiturate brings about death quickly. This wasn’t true in Betsy’s case – she lingered on for four hours. Given that the drug was a homemade cocktail of morphine, pentobarbital and chloral hydrate which smelled like paint, her friends were “lucky” that it worked. Some assisted suicide patients in Oregon have woken up to discover that their suicide has failed.

It wasn’t a good beginning for the law. 

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The ethics of Santa Claus disclosure

There is quite a bit of literature in bioethics journals about the ethics of telling white lies to patients, especially with terminally ill patients. There is much less discussion about a far more common ethical conundrum: whether children should be told the truth about Santa Claus. This, thankfully, has been remedied. Two psychologists have written an article in The Lancet Psychiatry arguing that children’s moral compass could be permanently deranged by the disappointment of learning that their parents have been telling them lies.

Kathy McKay, a clinical psychologist at the University of New England, Australia and a co-author, told The Guardian: “The Santa myth is such an involved lie, such a long-lasting one, between parents and children, that if a relationship is vulnerable, this may be the final straw. If parents can lie so convincingly and over such a long time, what else can they lie about?”

The psychologists follow in the footsteps of Richard Dawkins, who saw through the myth of Santa Claus at the tender age of 21 months. He told a conference in 2014: “Is it a good thing to go along with the fantasies of childhood, magical as they are? Or should we be fostering a spirit of scepticism? I think it's rather pernicious to inculcate into a child a view of the world which includes supernaturalism.”

We’d like to open up comments on BioEdge to a discussion of this issue. 

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Sanctity of life

In 2005 Peter Singer confidently forecast the demise of the "sanctity of life" by 2040. His objections to the idea were mainly philosophical, but he cited two piece of evidence. One was the amazing success of a South Korean scientist named Hwang Woo-suk in creating embryonic stem cell lines. The other was the continuing advance of legal assisted suicide and euthanasia. 

Within months, Hwang Woo-suk was exposed as one of the greatest scientific frauds of the last century. As for euthanasia, Singer could still be right (although fears do persist that it could become, in his words, a "holocaust)". One out of two is not an impressive result and does little to inspire confidence in his prediction. 

But there is another problem with Singer's critique of the sanctity of life argument, as we report this week. A British bioethicist, David Albert Jones, director of the Anscombe Bioethics Centre, points out that it was not Christians who "invented" the sanctity of life, but Singer and his cronies. In a very thought-provoking article in The New Bioethics, he says that "sanctity of life" is just a straw man set up to label discredit arguments against Singer's "quality of life" approach. It is a controversial thesis which deserves to be debated. 

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Margins of error

The shock of this week’s Presidential election in the United States has overshadowed other winners and losers on election night. Big Marijuana was a winner. Four states have legalised recreational marijuana and another four medical marijuana. Assisted suicide was a winner, with voters in Colorado passing a ballot initiative legalising it.

A big loser was the polling industry, which failed to predict Trump’s astonishing victory. This comes after other surprises (ie, failures) in the Brexit debate and the peace accord in Colombia.

And this has made pollsters’ clients suspicious. “A corporate market research project, you don’t know if your polling is shit because there’s no election day,” Dan Wagner, head of Democratic research firm Civis Analytics, told the Wall Street Journal. In politics, “there’s a day where you’re going to find out whether you were right or whether you’re an idiot.”

Since polling has become a weapon in bioethics policy debates on issues like euthanasia, abortion, or stem cell research, perhaps we can feel a bit more justified in our scepticism about polls which purport to show what the public thinks. It would be silly to say that polling is broken, but it certainly needs a good grease-and-oil change.   

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Angels of mercy

It appears that Canada has experienced a visitation from an “angel of mercy”, a media euphemism for a medical serial killer. Arrested this week, Elizabeth Wettlaufer allegedly killed eight patients in Ontario nursing homes since 2007. The Canadian media is describing her as one of Canada’s worst serial killers.

She faces stiff competition in other countries. In Italy, Daniela Poggiali, a nurse, was sentenced earlier this year over 13 deaths. In the US, Charles Cullen, a nurse. was sentenced in 2006 over the deaths of about 40 patients. In Germany Stephan Letter killed at least 29 patients in 2003 and 2004. And then there is Dr Harold Shipman, the quiet English doctor who killed 250 patients.

These horrors never seem to be mentioned when the legalization of euthanasia is being debated, but they should be. The existence of these mad “angels of mercy” demonstrates that some healthcare professionals feel compelled to kill the defenceless people entrusted to their care.

Legalisation creates a class of people who do the same thing but without the secrecy. In Belgium and the Netherlands, the bulk of the euthanasia business seems to be carried out by a handful of doctors. Some of them have killed scores of patients. What does that do to them? Why do they volunteer? Will there be more “angels of mercy” in jurisdictions where euthanasia is legal? These are all questions that need to be asked and answered. 

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